National demographic, economic and cultural trends are creating a need for hiring and retaining older workers. However, while many older people will prefer and/or need to work, chronic health problems occurring in mid-life or later can severely disrupt employment. This project addresses the burden of depression on workers 50 years of age or older. The long-range goal is to disseminate an innovative program to help such workers remain engaged and productive in their work. Named the Work and Health Initiative (WHI), this community-based program provides mental health and vocational services to improve functioning and reduce productivity loss. Employee Assistance Program (EAP) counselors provide WHI care. This 46-month long study, which will be conducted in collaboration with OptumHealth, has two specific aims. Aim 1 is to prepare for a randomized controlled trial (RCT) of the WHI. Aim 2 is to conduct the RCT. This RCT will compare a usual care group of 300 employees to a WHI treatment group consisting of 200 employees (who will receive up to eight telephone visits with an EAP counselor over four months). Employees will be recruited from multiple worksites served by the OptumHealth EAP. Inclusion criteria include: age e 50 years, working e 15 hours/week, current major depression and/or dysthymia and work limitations. Several exclusions will apply. Analysis of covariance techniques will test the hypothesis that relative to usual care, the WHI improves the work outcomes of depression. Surveys administered at screening, baseline and four-month follow-up will assess the primary endpoints;health-related work performance deficits (known as "presenteeism") and missed work time (absenteeism). Process of care will be evaluated using qualitative and quantitative data. A cost- benefit analysis will estimate the economic value of the WHI with data on productivity costs. Study results potentially will result in a new multi-disciplinary method for addressing a serious public health and employment issue, which is provided within EAP;an important but underused component of the community-based employee services infrastructure. PUBLIC HEALTH RELEVANCE: Middle-aged and older workers with chronic illnesses such as depression are vulnerable to a range of adverse work outcomes. However, services to help workers cope with work problems are fragmented and of limited effectiveness. The WHI has the potential to address this significant public health, employment and public policy issue.